THE percentage of emergency Caesarean sections at Hereford County Hospital has seen a significant rise  - with patients from Powys making for much of the increase.

Figures for April show were up to 16.5 per cent compared to 14.4 percent in March.

A review revealed a “disproportionate” number of women from Powys within that rise.

Powys does not have a dedicated maternity unit, high risk pregnancies are transferred to Hereford.

Wye Valley NHS Trust is investigating the potential for work with health providers in Powys on high risk pregnancies and the number of women sent over the border.

The trust board has been that consultants are “collaboratively  reviewing” the management of high risk pregnancies requiring induction.

This work will include the management of all patients and any additional work required to reduce the emergency and elective c-section rate month by month.

In December, the overall number of caesarean deliveries across the trust was recognised as too high.

Numbers put to that month’s meeting of the trust board were said to be well over internal targets.

Figures cited in  example showed that September last year the trust’s elective c-section  rate was 12.2 per cent and in October 13.3 per cent – both against the 9.7 per cent  national average for each month.

Emergency c-section rates were 17.1 per cent in September and 18.9 per cent in October against a 15.4 per cent national average for each month.

The board heard that the increase was “almost entirely attributable” to a rise in the numbers of women delivering in two specific category groups.

A classification system called Robson Ten provides a means of comparing  c-section rates by groups.

The trust attributes a rise to Robson Group 1 (spontaneously labouring first time mothers) and Robson Group 2 (women in their first pregnancy who are induced or have a c-section before labour).

Average monthly figures over July-September saw three c-sections  a month in Groups 1 & 2.

In October there were eight c-sections in Group 1  and nine in Group 2 which went against a reducing trend seen over six months.

Already, the trust’s head of quality & safety has discussed the rise with the consultant  lead for risk within the Integrated Family Health Service Unit.

Currently each emergency c-section is discussed at the labour ward and potentially avoidable  sections flagged to those involved.

Additional work is also currently been undertaken in relation to ascertaining comparable data between consultants and the feeding back of results.

The trust’s focus  remains on the reduction of both elective and emergency c-sections with work underway to implement “enhanced education” for midwives and obstetricians in relation to normalised birth.

C-sections are also subject to on-going audit for quarterly reports to the trust’s quality committee.

Where monitoring does not reveal a reduction in rates, additional reviews will be undertaken taking in factors as definitive as time of day and consultant presence.